AB1411 JOINT RHEUMA-DERMA CLINIC: FOUR YEARS OF EXPERIENCE AT THE SAN MARCO HOSPITAL IN CATANIA
Authors: R. Foti, G. Giuffrida, A. Ramondetta, E. Visalli, G. Amato, Y. Dal Bosco, F. De Lucia, R. Foti, R. De Pasquale
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriatic arthritis (PsA) affects up to one-third of patients with psoriasis. Many recent works in literature have underline that the percentage of undiagnosed PsA is still high. A direct collaboration between dermatologists and rheumatologists appears fundamental for a better management of these patients, to reduce the risk of joint damage, disability, and comorbidities. Objectives The aim of this study is to highlight the benefits of a Rheuma-Derma clinic and a shared approach, focused to an early diagnosis and prompt therapeutic strategy of PsA. Methods Patients with psoriasis complaining joint symptoms or rheumatologic patients with cutaneous involvement, were simultaneously assessed by a dermatologist and a rheumatologist. The collected data included demographics, clinical characteristics as joint patterns (axial/peripheral), clinimetric index evaluated (DAS28, HAQ, BASDAI, DAPSA, PASI, PGA) family history of psoriasis or PsA, BMI (Mass Body Index), psoriasis, comorbidities and Charlson Index, gastrointestinal and ophthalmic involvement, and previous and current treatments with conventional (csDMARDS) and/or biological therapy (bDMARDs). Results During the period from 2012 to 2016 the Rheumatology Department registered 255 of patients under biological treatment, against 374 of patients during the Rheuma-Derma Clinic (2017-2021), with an increase of 47% in number. CsDMARDs therapy counted 367 patients before the Rheuma-Derma Clinic and 539 after the shared outpatient activity, with a raise of the 46%. Globally the number of patients with the diagnosis of PsA moved from 622 to 913, reaching an increase of 47% of patients. The joint pattern have shown a peripheral involvement in 69.3% of cases in comparison to 11% of cases with axial involvement and a mixed for the rest of population, 19.8%. In the group analyzed 539 patients were treated with csDMARDs, 76.5% methotrexate, 30.7% salazopyrine and only 6.7% with cyclosporine. 374 patients under treatment with bDMARD: the majority of patients (86.1%) were treated with TNFα inhibitors, 25.4% Secukinumab, 20.1% Ustekinumab, 16% Apremilast, 4.8% Ixekizumab, 1.1% Tofacitinib. The Charlson Comorbidity Index (CCI) assesses comorbidity level by taking into account the number, the severity of pre-defined comorbid conditions and the age of patients. It provides a weighted score in a range from 0 to 8, which can be used to predict short term and long-term outcomes such as function, hospital length of stay and mortality rates. In our study the majority of patients (27%) had a score of 2 while fortunately only 0.5% of population had a score of 8. The most frequent comorbidities registred in our cohort were hypertension (24.6%) and dyslipidemia (28.3%). Psoriasis was diagnosed in 41% of patients: in 80% of them the skin disease preceded the articular symptoms while 20% of patients developed psoriasis after the arthritis onset. History of family psoriasis was positive in 26% of patients. The nails involvement was observed only in 8% of patients, followed by gastrointestinal disorders (3%) and uveitis (7%). The value of BMI (Body Mass Index), the majority of patients (56%) have shown a normal weight, followed by over-weight patients (31.7%); only 10% of patients presented an obesity grade I and 1.1% an obesity grade II-III. For all the clinimetric index evaluated (DAS28, HAQ, BASDAI, DAPSA, PASI, PGA), there was an improvement over the twelve months under the Reuma-Derma clinic Conclusion In conclusion, the diagnosis of an Early PsA is essential, as an early treatment and management can alter the natural course of PsA and prevent irreversible joint damage. Our experience proved the increased number of patients since the Rheuma-Derma Clinic have started, such as an increased number of patients under treatment, leading to a significant improvement in the quality of life of PsA and Pso patients. References [1]Mease PJ J Am Acad Dermatol. 2013;69:729–735. [2]Scher JU Nat Rev Rheumatol. 2019 Mar;15(3):153-166. [3]Radtke MA J Eur Acad Dermatol Venereol. 2009 Jun;23(6):683-91. doi: 10.1111/j.1468-3083.2009.03159.x Disclosure of Interests None declared